Is a Pregnant Woman’s Anxiety Disorder a Risk for Her Baby?
Research questions links between maternal disorders and infant health.
Posted November 1, 2017
By Cameron Evans
Pregnant women struggling with anxiety may have one less thing to worry about.
Although previous research has suggested that anxiety and panic disorders in pregnant women could have negative outcomes for their babies, such as low birth weight and premature birth, new findings by Yale researchers do not support that conclusion. The new findings may come as a relief to many women, given that up to 5 percent of women have panic disorder and as many as 10 percent have generalized anxiety disorder (GAD).
The data also suggest that pregnant women’s use of medications commonly taken to treat these conditions—serotonin reuptake inhibitors (SRI) and benzodiazepines—are associated with increases in some risks. Yet the researchers characterize the rate of occurrence of adverse outcomes as “modest.”
The study, published in JAMA Psychiatry, was based on interviews with more than 2,600 women during pregnancy and in the weeks that followed. Ninety-eight of the participants met the researchers’ criteria for panic disorder and 252 did so for generalized anxiety disorder. At some point during their pregnancy, 67 participants reported taking a benzodiazepine medication and 293 reported taking a SRI.
While previous studies of these disorders and their effects on pregnancy were based on existing birth registry data, the new findings are based on prospective analysis of a large group of women. “We have a fine-grained assessment of what psychiatric illnesses they had, as well as the medication they took,” says lead study author Kimberly Ann Yonkers, a psychiatrist and professor at Yale’s School of Public Health. “I think that is far stronger than relying on medical record diagnosis, which forms a basis of a lot of the registry studies.”
The researchers statistically controlled for factors that might have produced an apparent association between the disorders and pregnancy-related complications, such as drinking, smoking, and drug use. They found that having panic disorder or generalized anxiety disorder was not, by itself, associated with complications.
In contrast, the use of benzodiazepines was associated with increased occurrence of low birth weight, cesarean delivery, and neonatal respiratory distress, while use of SRIs was associated with preterm birth, hypertensive diseases of pregnancy, and the need for minor respiratory intervention after delivery. Still, the effects were relatively uncommon and mild, Yonkers says: “Certainly what we’re seeing in terms of birth outcomes with regard to serotonin reuptake inhibitors and maybe even benzodiazepine is that they’re not as bad as smoking in pregnancy, for example.”
Interpreting these findings for clinical use may be difficult because “information regarding doses and frequency of medication used were not reported” and might have affected outcomes, according to Janice Goodman, a professor in the School of Nursing at the Massachusetts General Hospital Institute of Health Professions, who was not involved in the current study but who has studied pregnancy and anxiety.
“Medications used in treating these disorders may have mild adverse outcomes,” Goodman says. “Therefore, the risks and benefits of using medication to treat anxiety during pregnancy must be carefully weighed and non-pharmacologic treatments preferentially considered.”
There is plenty more research to be done, Yonkers says. Ultimately, the decision to use anxiety medications during pregnancy must be made by an individual in conjunction with her family and her physician. Still, she notes, “the data are very reassuring with regard to the illness, in and of itself, not being associated with a number of adverse maternal and neonatal outcomes.”
Yonkers, K. A., Gilstad-Hayden, K., Forray, A., & Lipkind, H. S. (2017). Association of Panic Disorder, Generalized Anxiety Disorder, and Benzodiazepine Treatment During Pregnancy With Risk of Adverse Birth Outcomes. JAMA Psychiatry.